Abstract 591
Background
FLOT chemotherapy is a standard of care for patients with early gastric & gastroesophageal junction adenocarcinoma: 4 cycles pre- and 4 post-surgery. It was introduced at the Clatterbridge Cancer Centre in October 2017 following the presentation of FLOT4 trial data. Primary prophylaxis with GCSF was not part of the trial protocol but was allowed as per investigator’s discretion. As such GCSF was not included in the FLOT regimen initially in our centre. However, a significant number of patients could not proceed with their second cycle on time due to prolonged grade 3-4 neutropenia or neutropenic infection. Therefore, primary GCSF prophylaxis was introduced from day 5 of each cycle for 5 days at doses of 300 & 480 micrograms for patients with weight <70 and >70 kg, respectively.
Methods
Patients were identified from chemotherapy-prescribing records and data was collected from their electronic notes. As a primary objective we compared rates of dose delay because of neutropenia before and after introducing primary GCSF prophylaxis. We also looked at other reasons for dose delay & reduction.
Results
47 patients started FLOT between October 2017 & July 2018; 41 were men and median age was 63.7 years (36-79). 2 patients had FLOT only in the adjuvant setting. In patients who started neoadjuvant FLOT, 27 patients (57.4%) went on to receive FLOT adjuvantly. 19 patients (40.4%) completed 8 cycles and the median number of cycles received was 5.6 (1-8 cycles). 13 patients had FLOT without primary GCSF prophylaxis, 61.6% of them had dose delays because of neutropenia. After the addition of primary GCSF prophylaxis, the rate of neutropenia resulting in dose delay fell to 2.9% (p = 0.00). 46.8% of patients had their treatment delayed for reasons other than neutropenia with the highest rates of deferral seen for non-neutropenic infection (10.6%) and nausea & vomiting (10.6%). 31.9% of patients had their treatment dose reduced; this was most commonly for diarrhoea (10.6%) and peripheral neuropathies (8.5%).
Conclusions
61.6% of patients receiving the FLOT regimen had treatment delays because of neutropenia. Primary GCSF prophylaxis almost eliminated this problem and reduced the overall rate of dose delays. Therefore, primary GCSF prophylaxis should routinely be used with FLOT.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
3159 - Anlotinib for advanced hepatocellular carcinoma: interim results from the phase II ALTER0802 study
Presenter: AiPing Zhou
Session: Poster Display session 2
Resources:
Abstract
3191 - The efficacy and safety of lenvatinib in patients who did not meet the inclusion criteria of the phase 3 trial (REFLECT trial) and those with BCLC Stage B hepatocellular carcinoma - A nationwide multicenter study in Japan-
Presenter: Azusa Sakamoto
Session: Poster Display session 2
Resources:
Abstract
1529 - Prognostic and predictive value of baseline alpha-fetoprotein (AFP) in patients with advanced hepatocellular carcinoma (HCC) treated with ramucirumab from two phase 3 studies (REACH, REACH-2)
Presenter: Andrew Zhu
Session: Poster Display session 2
Resources:
Abstract
2767 - Effect of second-line cabozantinib on health states for patients with advanced hepatocellular carcinoma (aHCC) after sorafenib: QTWiST analysis from the CELESTIAL study
Presenter: Nicholas Freemantle
Session: Poster Display session 2
Resources:
Abstract
2150 - Alpha-fetoprotein (AFP) response in patients with unresectable hepatocellular carcinoma (HCC) in the phase 3 RESORCE trial
Presenter: Jordi Bruix
Session: Poster Display session 2
Resources:
Abstract
3437 - Phase I/II trial of NBTXR3 activated by SBRT in patients with hepatocellular carcinoma or liver metastasis
Presenter: Marc Pracht
Session: Poster Display session 2
Resources:
Abstract
1758 - Efficacy and safety of ramucirumab (RAM) for advanced hepatocellular carcinoma (HCC) with elevated alpha-fetoprotein (AFP) following first-line sorafenib across age subgroups in two global phase 3 trials (REACH and REACH-2)
Presenter: Masatoshi Kudo
Session: Poster Display session 2
Resources:
Abstract
1192 - Ramucirumab in patients with advanced hepatocellular carcinoma (HCC) and elevated alpha fetoprotein (AFP): An exposure–response analysis
Presenter: Josep Llovet
Session: Poster Display session 2
Resources:
Abstract
1600 - Outcomes of Hepatocellular Carcinoma (HCC) Patients Treated with Nivolumab: The Mount Sinai Hospital Experience.
Presenter: Sirish Dharmapuri
Session: Poster Display session 2
Resources:
Abstract
2364 - Pembrolizumab vs Chemotherapy in Patients With Advanced/Metastatic Adenocarcinoma (AC) or Squamous Cell Carcinoma (SCC) of the Esophagus as Second-Line Therapy: Analysis of the Chinese Subgroup in KEYNOTE-181
Presenter: Jia Chen
Session: Poster Display session 2
Resources:
Abstract